Thyroid Stimulating Hormone Levels and Risk of Hospital-Acquired Acute Kidney Injury: A Nationwide Cohort Study

Résumé fourni par la source

Rationale & Objective The thyroid–renal interaction remains underexplored in acute kidney injury pathophysiology. We aimed to investigate the relationship between thyroid status, defined by thyroid-stimulating hormone (TSH) levels, and incident hospital-acquired acute kidney injury (HA-AKI). Study Design A retrospective cohort study. Setting & Participants Patients with TSH quantification within 48 hours after admission from the China Renal Data System (CRDS) database. Exposure(s) Three TSH levels groups, including hyperthyroid (TSH ≤ 0.5 mIU/L), euthyroid (0.5 < TSH ≤ 5.0 mIU/L), and hypothyroid (TSH > 5.0 mIU/L) TSH levels. Outcome(s) The primary outcome was HA-AKI. Analytical Approach Multivariable Cox hazard regression models and restricted cubic spline. Results A total of 20,317 (5.4%) patients developed HA-AKI, with incidences rates of 8.0%, 5.0%, and 6.4% in patients with hyperthyroid, euthyroid, and hypothyroid TSH levels, respectively. Compared with patients with euthyroid TSH levels, those with hyperthyroid or hypothyroid TSH levels were associated with an increased risk of HA-AKI (hyperthyroid TSH levels: adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.21-1.37; P < 0.001; hypothyroid TSH levels: aHR, 1.10; 95% CI, 1.01-1.21; P = 0.03). Additionally, the dose-response curve showed a U-shaped relationship between TSH levels and the risk of new-onset HA-AKI. Limitations Possible residual confounding. Conclusions TSH levels in the low (≤0.5 mIU/L) and high (>5.0 mIU/L) ranges were associated with increased risk of HA-AKI. These insights suggest that enhanced vigilance toward AKI may be justifiable in patients with thyroid dysfunction. Plain-Language Summary The relationship between thyroid dysfunction and chronic kidney disease (CKD) has been extensively studied. However, there is a lack of consensus regarding whether thyroid disorders increase the risk of acute kidney injury (AKI). To address this issue, this national cohort study used thyroid-stimulating hormone (TSH) levels as the primary exposure variable to assess thyroid function, categorizing them into three groups and evaluating the relationship between TSH levels and incident hospital-acquired acute kidney injury (HA-AKI). The results demonstrated that TSH levels in both low and high levels were associated with an increased risk of HA-AKI. Disruptions in the thyroid axis may serve as a predictor of patient outcomes. Therefore, prompt evaluation of thyroid function may be recommended to detect AKI in high-risk populations.

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